Lettuce romaine calm and manage our glycemia: adding leafy greens to a meal may improve postprandial metabolism,Lipids in Health and Disease

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Lettuce romaine calm and manage our glycemia: adding leafy greens to a meal may improve postprandial metabolism
Lipids in Health and Disease ( IF 4.5 ) Pub Date : 2021-07-15 , DOI: 10.1186/s12944-021-01495-9
Gregory C Henderson ₁

Affiliation

When considering lifestyle factors such as consumption of fruits and vegetables, and leading a physically active lifestyle, the benefits are often ascribed to the long-term, chronic effects of each lifestyle factor. An example of this long-term mindset would be views of antioxidant biology; long-term intakes of anti-oxidants could potentially prevent the accumulation of oxidative damage to DNA and other cellular constituents that accumulate over months and years. However, it is important to note that lifestyle factors (e.g., nutrition) typically have both acute and chronic effects. The acute effects of nutrient intake can be manifested as a modification of postprandial metabolism following the individual meal in which that specific food was consumed. With a substantial portion of each day spent in the postprandial state, any effects of diet selection on postprandial metabolism could exert major health impacts. It is a well-accepted goal to maintain blood glucose and blood lipids within desirable ranges over the course of each day, and these factors respond to the components of each individual meal. Following each mixed meal, circulating levels of glucose and triacylglycerol (TAG) rise and then fall. Each rise contributes to the subject’s lifetime total exposure of blood vessels and tissues to these metabolites. The acute effects of each meal accumulate over the years. While the majority of nutrition research in the past has been focused on chronic intake of foods, the acute effects of consuming specific foods within a meal are also important for understanding health properties of nutrition.

Including specific foods into a meal may modify the stresses imposed upon metabolism following that meal. For example, as discussed above, glucose and lipoprotein responses to a meal could be modified by specific foods or food groups. General effects of dietary fiber and macronutrient composition in test meals upon blood glucose and TAG have been elucidated previously [4, 10]; however, significant gaps in knowledge remain. To translate our understanding to real-world application, a greater level of information is needed in relation to the intake of complex dietary components that simultaneously deliver digestible macronutrients, fiber, micronutrients, and trace levels of other important biologically active compounds. Specific foods, such as leafy green vegetables, might have impacts that are beyond those which we would predict based upon our current understanding. To develop knowledge about the benefits of specific foods that are likely to be healthful, acute studies of specific foods are needed, such as specific leafy greens and other vegetables.

It is of public health interest that blood glucose and TAG rise in individuals following consumption of each mixed meal, because postprandial responses of blood glucose [5] and TAG [1] are risk factors for developing metabolic and cardiovascular diseases. Thus, developing new approaches to blunt the responses is desirable. In the current issue of Lipids in Health and Disease, Shokraei and colleagues [12] performed a randomized, controlled, cross-over trial to investigate acute responses to three different meals. In this study of healthy young men, the authors administered test meals to study the acute responses of blood glucose and lipoproteins. The work of Shokraei et al. is important for advancing the field forward, and it will be advantageous to the scientific community if a greater number of such translational studies of acute nutrition are conducted in the future by investigators around the world. In the study by Shokraei et al. [12], each meal contained approximately 800 kcal of energy with a macronutrient composition that somewhat reasonably matches that of a typical daily intake, with the majority of energy from carbohydrate (CHO), a substantial proportion of energy from fat, and the remaining balance from protein (~ 50% CHO, ~ 40% fat, ~ 10% protein). On each of 3 occasions, participants consumed the meal with addition of romaine lettuce, watercress, or inclusion of cellulose (fiber) to the control meal in place of the leafy green vegetables. Blood was drawn periodically over 4 h following each meal for tracking of blood glucose and lipoproteins. As compared with the fiber-containing control meal, addition of these leafy greens did not significantly alter the responses of circulating TAG or other components of the lipoprotein profile. However, the postprandial blood glucose response was blunted when lettuce was consumed with the meal, in comparison to meals containing watercress or fiber supplement. While blood glucose rose following the meals containing cellulose or watercress, when the meal contained lettuce blood glucose actually trended downward in the postprandial period. This divergent response in the lettuce trial led to a significant main effect of the meal in the statistical analysis, indicating that the post-meal blood glucose profile was lower in the lettuce-containing meal. It is noteworthy that the response to romaine lettuce could not be recapitulated by addition of a different leafy green (watercress) or by fiber intake alone. Thus, the benefits of romaine lettuce intake upon glycemic control may be unique to this specific food, and it is unknown how generalizable this discovery is to other types of vegetables and other types of lettuce. The findings are encouraging and point to a need for additional research.

The work by Shokraei and colleagues is an excellent example of translational science. In translational research, it is ideal to develop a study design that incorporates aspects of the real-world experience of humans, in order to maximize clinical relevance. The authors have achieved this goal by testing specific leafy vegetables within a well-controlled test meal. They have tested real foods that one may select for inclusion in meals in daily life, yet they conducted the research in a laboratory setting with application of useful biochemical measurements. Thus, the work was translational as it was within the spectrum from basic science to clinical research (or from “bench to bedside”), incorporating aspects of basic science laboratory control as well as aspects of real-world meal consumption. Often in translational studies of postprandial metabolism, physical activity on the day of experimentation is rigidly controlled. For example, to exclude potential impacts of physical activity when studying nutrition, often subjects would be asked to remain nearly motionless for the entire day. When physical activity is limited in this situation, the trials would be scheduled on days when students need not attend class or when employed individuals need not report to their jobs. However, Shokraei and colleagues took a different approach and chose to allow greater levels of physical activity in the participants. The research subject population included students, and subjects were permitted to leave the laboratory between blood draws to attend classes [12]. The authors report that approximately 40% of the subjects did walk to classes between blood draws. Allowing participants to carry out these activities reflects the translational nature of the study, as it makes the study design similar to a normal day in the life of the participants. However, while this lack of physical activity control perhaps makes the results applicable to the real world, it is also a potential weakness of the study. It is known from previous publications that a recent bout of exercise can reduce blood glucose and plasma TAG for hours [3, 7, 8]. While the subjects did not exercise at any intense level, one could postulate that bouts of walking might have some similar effect, yet to a lesser extent. Indeed, it has been reported that even brief bouts of walking spaced throughout the day, to break up sedentary sitting behavior, can reduce blood glucose concentrations [2, 6, 9, 11]. Thus, permitting subjects to leave the laboratory on foot between blood draws in the study by Shokraei et al. could have led to reduced blood glucose levels. Nonetheless, the authors report that physical activity patterns were similar between the lettuce, watercress, and fiber control trials; therefore, it is expected that the findings for effects of lettuce upon blood glucose are valid, yet it should be noted that the benefits of lettuce were observed on the background of the potential benefits of physical activity in nearly half of the participants. This mixture of possible physical activity effects and food effects upon metabolism is of course what occurs in real daily life, and it might be of interest in the future to further explore any interactions between physical activity and vegetable intake upon postprandial blood glucose levels. Clearly, the study by Shokraei and colleagues paves the way for future work on other dietary components, clinical populations, and potential interactions between diet and physical activity. Their study represents a valuable step forward in our understanding of dietary patterns and health. Additionally, as is often the case with impactful research, the study leads to many questions that will require future studies to fill the remaining knowledge gaps.

The study by Shokraei and colleagues exemplifies the notion that healthy foods need not be consumed regularly, for many months, in order to achieve initial health benefits. While long-term intake of leafy greens is certainly advisable, inclusion of certain leafy vegetables (such as romaine lettuce) in even a single meal can improve the postprandial metabolic milieu on that occasion through acute effects upon metabolism. The cumulative effect of the 24-h integrated blood glucose and lipid levels, over many months and years, ultimately exerts a meaningful impact on one’s disease risk; a promising approach for reducing this risk is to focus upon improving the postprandial response to each individual meal by including foods which exert acute effects upon postprandial metabolism. Discovering ways to alter the response of glycemia to each meal would be of high clinical value, such that over the years an individual experiences a lower total exposure of blood vessels to glucose. Thus, the authors are commended for performing a valuable study of the acute responses to nutrition. This study [12] is very encouraging and is supportive of the concept that foods can exert their benefits through acute effects upon metabolism immediately following consumption. Studying romaine lettuce has led to important new knowledge, and the findings may inspire future work on other potentially healthful components of the diet. Considering the vast number of leafy greens and other vegetables available to consumers, it is clear that the present results about lettuce may only be the tip of the iceberg.

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Department of Nutrition Science, Purdue University, 700 West State Street, West Lafayette, IN, 47907, USA
Gregory C. Henderson

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Henderson, G.C. Lettuce romaine calm and manage our glycemia: adding leafy greens to a meal may improve postprandial metabolism. Lipids Health Dis 20, 67 (2021). https://doi.org/10.1186/s12944-021-01495-9

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Published: 15 July 2021
DOI: https://doi.org/10.1186/s12944-021-01495-9

中文翻译：

生菜长叶莴苣镇静和控制我们的血糖：在膳食中添加绿叶蔬菜可以改善餐后新陈代谢

在考虑生活方式因素（例如水果和蔬菜的消费）以及积极的生活方式时，其益处通常归因于每种生活方式因素的长期、慢性影响。这种长期心态的一个例子是抗氧化生物学的观点。长期摄入抗氧化剂可能会阻止对 DNA 和其他细胞成分的氧化损伤的积累，这些损伤会在数月和数年内积累。然而，重要的是要注意生活方式因素（例如，营养）通常具有急性和慢性影响。营养摄入的急性影响可以表现为在食用特定食物的单餐后餐后代谢的改变。每天大部分时间都处于餐后状态，饮食选择对餐后代谢的任何影响都可能对健康产生重大影响。在每天的过程中将血糖和血脂保持在理想范围内是一个广为接受的目标，这些因素对每餐的成分有反应。每次混合膳食后，葡萄糖和三酰基甘油 (TAG) 的循环水平上升然后下降。每次升高都会导致受试者一生中血管和组织对这些代谢物的总暴露量。多年来，每餐的急性影响不断累积。虽然过去的大多数营养研究都集中在食物的长期摄入上，但在一顿饭中食用特定食物的急性影响对于了解营养的健康特性也很重要。在每天的过程中将血糖和血脂保持在理想范围内是一个广为接受的目标，这些因素对每餐的成分有反应。每次混合膳食后，葡萄糖和三酰基甘油 (TAG) 的循环水平上升然后下降。每次升高都会导致受试者一生中血管和组织对这些代谢物的总暴露量。多年来，每餐的急性影响不断累积。虽然过去的大多数营养研究都集中在食物的长期摄入上，但在一顿饭中食用特定食物的急性影响对于了解营养的健康特性也很重要。在每天的过程中将血糖和血脂保持在理想范围内是一个广为接受的目标，这些因素对每餐的成分有反应。每次混合膳食后，葡萄糖和三酰基甘油 (TAG) 的循环水平上升然后下降。每次升高都会导致受试者一生中血管和组织对这些代谢物的总暴露量。多年来，每餐的急性影响不断累积。虽然过去的大多数营养研究都集中在食物的长期摄入上，但在一顿饭中食用特定食物的急性影响对于了解营养的健康特性也很重要。这些因素对每餐的成分有反应。每次混合膳食后，葡萄糖和三酰基甘油 (TAG) 的循环水平上升然后下降。每次升高都会导致受试者一生中血管和组织对这些代谢物的总暴露量。多年来，每餐的急性影响不断累积。虽然过去的大多数营养研究都集中在食物的长期摄入上，但在一顿饭中食用特定食物的急性影响对于了解营养的健康特性也很重要。这些因素对每餐的成分有反应。每次混合膳食后，葡萄糖和三酰基甘油 (TAG) 的循环水平上升然后下降。每次升高都会导致受试者一生中血管和组织对这些代谢物的总暴露量。多年来，每餐的急性影响不断累积。虽然过去的大多数营养研究都集中在食物的长期摄入上，但在一顿饭中食用特定食物的急性影响对于了解营养的健康特性也很重要。

在一顿饭中加入特定的食物可能会改变那顿饭后对新陈代谢施加的压力。例如，如上所述，对一餐的葡萄糖和脂蛋白反应可以通过特定的食物或食物组来改变。试验膳食中膳食纤维和常量营养素成分对血糖和 TAG 的一般影响已在之前得到阐明 [4, 10]；然而，知识方面的重大差距仍然存在。为了将我们的理解转化为实际应用，需要更多与摄入复杂膳食成分相关的信息，这些成分同时提供可消化的大量营养素、纤维、微量营养素和微量其他重要的生物活性化合物。特定的食物，例如绿叶蔬菜，可能会产生超出我们根据当前理解预测的影响。为了了解可能有益健康的特定食物的益处，需要对特定食物进行深入研究，例如特定的绿叶蔬菜和其他蔬菜。

食用每种混合膳食后，个体的血糖和 TAG 会升高，这具有公共卫生利益，因为餐后血糖 [5] 和 TAG [1] 的反应是发生代谢和心血管疾病的危险因素。因此，开发新的方法来减弱反应是可取的。在当前的健康与疾病中的脂质问题中，Shokraei 及其同事 [12] 进行了一项随机、对照、交叉试验，以研究对三种不同膳食的急性反应。在这项针对健康年轻男性的研究中，作者进行了测试餐以研究血糖和脂蛋白的急性反应。Shokraei 等人的工作。对于推动该领域的发展非常重要，如果未来世界各地的研究人员开展更多此类急性营养转化研究，这将对科学界有利。在 Shokraei 等人的研究中。[12]，每餐含有大约 800 kcal 的能量，其常量营养素成分与典型的每日摄入量相当匹配，大部分能量来自碳水化合物 (CHO)，大部分能量来自脂肪，其余的来自蛋白质（~ 50% CHO，~ 40% 脂肪，~ 10% 蛋白质）。在 3 次中的每一次，参与者都在用餐时加入生菜、豆瓣菜或在对照餐中加入纤维素（纤维）来代替绿叶蔬菜。每餐后 4 小时内定期抽血以跟踪血糖和脂蛋白。与含纤维的对照餐相比，添加这些绿叶蔬菜并没有显着改变循环 TAG 或脂蛋白谱的其他成分的反应。然而，与含有豆瓣菜或纤维补充剂的膳食相比，当餐时食用生菜时，餐后血糖反应会减弱。含纤维素或西洋菜的膳食后血糖升高，当膳食中含有生菜时，餐后血糖实际上呈下降趋势。生菜试验中的这种不同反应导致膳食在统计分析中的主效应显着，表明含生菜的膳食中的餐后血糖曲线较低。值得注意的是，不能通过添加不同的绿叶蔬菜（豆瓣菜）或单独摄入纤维来概括对长叶莴苣的反应。因此，长叶莴苣摄入对血糖控制的益处可能是这种特定食物所独有的，而且尚不清楚这一发现对其他类型的蔬菜和其他类型的生菜有多大的推广意义。研究结果令人鼓舞，并指出需要进行更多研究。生菜试验中的这种不同反应导致膳食在统计分析中的主效应显着，表明含生菜的膳食中的餐后血糖曲线较低。值得注意的是，不能通过添加不同的绿叶蔬菜（豆瓣菜）或单独摄入纤维来概括对长叶莴苣的反应。因此，长叶莴苣摄入对血糖控制的益处可能是这种特定食物所独有的，而且尚不清楚这一发现对其他类型的蔬菜和其他类型的生菜有多大的推广意义。研究结果令人鼓舞，并指出需要进行更多研究。生菜试验中的这种不同反应导致膳食在统计分析中的主效应显着，表明含生菜的膳食中的餐后血糖曲线较低。值得注意的是，不能通过添加不同的绿叶蔬菜（豆瓣菜）或单独摄入纤维来概括对长叶莴苣的反应。因此，长叶莴苣摄入对血糖控制的益处可能是这种特定食物所独有的，而且尚不清楚这一发现对其他类型的蔬菜和其他类型的生菜有多大的推广意义。研究结果令人鼓舞，并指出需要进行更多研究。值得注意的是，不能通过添加不同的绿叶蔬菜（豆瓣菜）或单独摄入纤维来概括对长叶莴苣的反应。因此，长叶莴苣摄入对血糖控制的益处可能是这种特定食物所独有的，而且尚不清楚这一发现对其他类型的蔬菜和其他类型的生菜有多大的推广意义。研究结果令人鼓舞，并指出需要进行更多研究。值得注意的是，不能通过添加不同的绿叶蔬菜（豆瓣菜）或单独摄入纤维来概括对长叶莴苣的反应。因此，长叶莴苣摄入对血糖控制的益处可能是这种特定食物所独有的，而且尚不清楚这一发现对其他类型的蔬菜和其他类型的生菜有多大的推广意义。研究结果令人鼓舞，并指出需要进行更多研究。

Shokraei 及其同事的工作是转化科学的一个很好的例子。在转化研究中，理想的是开发一种结合人类现实世界经验的研究设计，以最大限度地提高临床相关性。作者通过在控制良好的测试餐中测试特定的多叶蔬菜实现了这一目标。他们已经测试了人们可能选择在日常生活中加入膳食的真实食物，但他们在实验室环境中进行了研究，并应用了有用的生化测量方法。因此，这项工作具有转化性，因为它在从基础科学到临床研究（或从“实验室到床边”）的范围内，结合了基础科学实验室控制的各个方面以及现实世界膳食消耗的各个方面。通常在餐后代谢的转化研究中，实验当天的身体活动受到严格控制。例如，为了在研究营养时排除身体活动的潜在影响，通常会要求受试者一整天几乎一动不动。在这种情况下，如果身体活动受到限制，则试验将安排在学生无需上课或受雇人员无需上班的日子。然而，Shokraei 及其同事采取了不同的方法，并选择让参与者进行更高水平的体育锻炼。研究对象人群包括学生，并且对象被允许在抽血之间离开实验室去上课[12]。作者报告说，大约 40% 的受试者在抽血之间确实步行去上课。允许参与者进行这些活动反映了研究的转化性质，因为它使研究设计类似于参与者生活中的正常一天。然而，虽然缺乏身体活动控制可能使结果适用于现实世界，但这也是该研究的潜在弱点。从以前的出版物中得知，最近的一次运动可以在数小时内降低血糖和血浆 TAG [3, 7, 8]。虽然受试者没有进行任何高强度的运动，但人们可以假设几回合的步行可能会产生一些类似的效果，但程度较轻。事实上，据报道，即使是一整天的短暂步行，也可以打破久坐不动的行为，可以降低血糖浓度 [2, 6, 9, 11]。因此，在 Shokraei 等人的研究中，允许受试者在抽血之间步行离开实验室。可能导致血糖水平降低。尽管如此，作者报告说，生菜、豆瓣菜和纤维对照试验之间的体力活动模式相似。因此，预计莴苣对血糖影响的研究结果是有效的，但应该注意的是，近一半的参与者在体育活动的潜在益处的背景下观察到了生菜的益处。这种可能的身体活动影响和食物对新陈代谢的影响的混合当然是现实日常生活中发生的情况，未来可能有兴趣进一步探索体力活动和蔬菜摄入对餐后血糖水平的相互作用。显然，Shokraei 及其同事的研究为未来研究其他饮食成分、临床人群以及饮食与身体活动之间的潜在相互作用铺平了道路。他们的研究代表了我们在了解饮食模式和健康方面向前迈出了宝贵的一步。此外，与有影响力的研究一样，该研究导致许多问题，需要未来的研究来填补剩余的知识空白。他们的研究代表了我们在了解饮食模式和健康方面向前迈出了宝贵的一步。此外，与有影响力的研究一样，该研究导致许多问题，需要未来的研究来填补剩余的知识空白。他们的研究代表了我们在了解饮食模式和健康方面向前迈出了宝贵的一步。此外，与有影响力的研究一样，该研究导致许多问题，需要未来的研究来填补剩余的知识空白。

Shokraei 及其同事的研究举例说明了健康食品不需要连续几个月定期食用，以获得初步的健康益处。虽然长期摄入绿叶蔬菜当然是可取的，但即使在单餐中加入某些绿叶蔬菜（如长叶莴苣）也可以通过对新陈代谢的急性影响改善餐后代谢环境。24 小时综合血糖和血脂水平的累积效应，经过数月和数年，最终对一个人的疾病风险产生有意义的影响；降低这种风险的一个有希望的方法是通过包括对餐后新陈代谢产生急性影响的食物来专注于改善对每一餐的餐后反应。发现改变血糖对每餐的反应的方法将具有很高的临床价值，因此多年来个体经历的血管对葡萄糖的总暴露量较低。因此，作者因对营养的急性反应进行了有价值的研究而受到赞扬。这项研究 [12] 非常令人鼓舞，并支持食物可以通过在食用后立即对新陈代谢产生急性影响来发挥其益处的概念。研究生菜带来了重要的新知识，这些发现可能会激发未来对饮食中其他潜在健康成分的研究。考虑到消费者可以获得大量绿叶蔬菜和其他蔬菜，很明显，目前关于生菜的结果可能只是冰山一角。因此，多年来，个体经历的血管对葡萄糖的总暴露量较低。因此，作者因对营养的急性反应进行了有价值的研究而受到赞扬。这项研究 [12] 非常令人鼓舞，并支持食物可以通过在食用后立即对新陈代谢产生急性影响来发挥其益处的概念。研究生菜带来了重要的新知识，这些发现可能会激发未来对饮食中其他潜在健康成分的研究。考虑到消费者可以获得大量绿叶蔬菜和其他蔬菜，很明显，目前关于生菜的结果可能只是冰山一角。因此，多年来，个体经历的血管对葡萄糖的总暴露量较低。因此，作者因对营养的急性反应进行了有价值的研究而受到赞扬。这项研究 [12] 非常令人鼓舞，并支持食物可以通过在食用后立即对新陈代谢产生急性影响来发挥其益处的概念。研究生菜带来了重要的新知识，这些发现可能会激发未来对饮食中其他潜在健康成分的研究。考虑到消费者可以获得大量绿叶蔬菜和其他蔬菜，很明显，目前关于生菜的结果可能只是冰山一角。作者因对营养的急性反应进行了有价值的研究而受到赞扬。这项研究 [12] 非常令人鼓舞，并支持食物可以通过在食用后立即对新陈代谢产生急性影响来发挥其益处的概念。研究生菜带来了重要的新知识，这些发现可能会激发未来对饮食中其他潜在健康成分的研究。考虑到消费者可以获得大量绿叶蔬菜和其他蔬菜，很明显，目前关于生菜的结果可能只是冰山一角。作者因对营养的急性反应进行了有价值的研究而受到赞扬。这项研究 [12] 非常令人鼓舞，并支持食物可以通过在食用后立即对新陈代谢产生急性影响来发挥其益处的概念。研究生菜带来了重要的新知识，这些发现可能会激发未来对饮食中其他潜在健康成分的研究。考虑到消费者可以获得大量绿叶蔬菜和其他蔬菜，很明显，目前关于生菜的结果可能只是冰山一角。研究生菜带来了重要的新知识，这些发现可能会激发未来对饮食中其他潜在健康成分的研究。考虑到消费者可以获得大量绿叶蔬菜和其他蔬菜，很明显，目前关于生菜的结果可能只是冰山一角。研究生菜带来了重要的新知识，这些发现可能会激发未来对饮食中其他潜在健康成分的研究。考虑到消费者可以获得大量绿叶蔬菜和其他蔬菜，很明显，目前关于生菜的结果可能只是冰山一角。

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